Overall, the Los Angeles Healthy Kids program has greatly improved coverage and access to dental care services for children enrolled in the program. However, as with many public insurance programs, the Los Angeles Healthy Kids program has been confronted with numerous challenges in meeting the dental care needs of program enrollees, such as initially assigning different dentists to some enrollees than they had selected, confusion over charges for dental services and underreporting of encounter data.

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture. Washington, DC: The Urban Institute. November 2009.

For 25 years, low-income, non-citizen Los Angeles County residents ineligible for Medi-Cal coverage have had access to emergency, pregnancy-related, and nursing home services through the Emergency Medi-Cal (EMC) program. With the 2003 creation of Healthy Kids, many children enrolled in EMC became eligible for more comprehensive coverage under Healthy Kids. But no formal mechanism was established to coordinate the programs, and the potential for children to be enrolled in both Healthy Kids and EMC was created. This study examines the benefits and challenges created by dual coverage and efforts made to capture state and federal funds to support Healthy Kids.

Less than two years after Massachusetts' 2006 reform law was implemented, 2.6 percent of residents were uninsured-the lowest proportion ever recorded in an American state. The state's individual mandate alone does not explain this result, since it is not enforced against adults with incomes at or below 150 percent FPL or children. During a multi-day site visit, researchers identified several factors contributing to Massachusetts' high enrollment, including an intensive marketing campaign; use of data to establish subsidy eligibility for newly-insured residents; an integrated eligibility system serving multiple subsidy programs with a single application; and healthcare provider/community-based organization-driven application assistance.

This Urban Institute study, with partner the National Academy for State Health Policy, presents findings from a 50-state analysis of Medicaid outreach and enrollment strategies targeting pregnant women. The study finds significant variation across states, but observes that the majority have policies to facilitate pregnant women's access to coverage through simplified enrollment; however, there is considerable room for improvement in outreach efforts and enhanced prenatal care. The paper presents policy recommendations for state officials to facilitate enrollment of pregnant women, raise public awareness of available coverage, and broaden the scope of prenatal care. The March of Dimes funded this study.